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Updated: May 9, 2026
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A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique
Published on: January 6, 2023
Fluoroscopically guided anterior atlantoaxial transarticular screws: a feasibility and trajectory study using
Mary R A Padua1, Jin S Yeom, So Y Lee
1Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-ku, Sungnam 463-707, Republic of Korea.
Summary
This study demonstrates that anterior transarticular screw (ATAS) fixation is anatomically feasible using specific fluoroscopic landmarks. The proposed trajectories avoid critical structures like the vertebral artery groove and spinal canal for safe C1-C2 stabilization.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Biomechanics
Background:
- Anterior transarticular screw (ATAS) fixation is a potential alternative to posterior stabilization techniques for the upper cervical spine.
- Limited research exists on using specific fluoroscopic landmarks to guide ATAS trajectories.
- This study addresses the gap in knowledge regarding the anatomical feasibility of landmark-guided ATAS placement.
Purpose of the Study:
- To determine the anatomical feasibility of anterior transarticular screw (ATAS) placement.
- To evaluate the safety and efficacy of using defined fluoroscopic landmarks for guiding ATAS screw trajectories.
- To compare the outcomes of four distinct screw trajectories for ATAS fixation.
Main Methods:
- Utilized 3D screw insertion simulation software and high-resolution computed tomographic (CT) scans of 100 patients.
- Simulated the placement of 4.0-mm screws using four defined fluoroscopic landmark-guided trajectories: promontory screw (PS), central facet (CF), medial facet (MF), and lateral facet (LF).
- Assessed the incidence of violations to the vertebral artery groove (C1/C2), spinal canal, and atlanto-occipital joint, alongside screw and purchase lengths.
Main Results:
- No violations of the C1/C2 vertebral artery groove or spinal canal were observed across all simulated screw trajectories.
- The promontory screw (PS) trajectory yielded the longest overall screw lengths and C2 purchase.
- Specific C1 purchase lengths were achieved with central facet (CF) and lateral facet (LF) screws, with no atlanto-occipital joint violation when C1 purchase was limited.
Conclusions:
- Anterior transarticular screw (ATAS) fixation appears anatomically feasible using the described entry points, trajectories, and fluoroscopic landmarks.
- The simulated trajectories successfully avoided the vertebral artery groove, spinal canal, and atlanto-occipital joint.
- This technique offers a potentially safe and effective method for C1-C2 stabilization in spinal surgery.
